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Journal of Clinical Microbiology, October 2004, p. 4828-4831, Vol. 42, No. 10
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.10.4828-4831.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

First Case of Arthrographis kalrae Ethmoid Sinusitis and Ophthalmitis in the People's Republic of China

Department of Dermatology, The Second Affiliated Hospital,¹ Department of Ophthalmology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China,³ Research Center for Pathogenic Fungi and Microbial Toxicoses, Chiba University, Chiba, Japan²

Received 30 November 2003/ Returned for modification 26 January 2004/ Accepted 6 May 2004

We present here the first case in the People's Republic of China of human disease caused by the fungus Arthrographis kalrae. The male patient had fungal panophthalmitis and invasive sinusitis involving the maxillary and ethmoid sinuses. He was an apparently healthy man before receiving trauma to his left eye. He complained of pain and loss of visual acuity in the injured eye, which displayed redness and edema and eventually discharged pus. His symptoms became more severe after he was treated with steroids and several antibacterial agents. A computed tomography scan of the left eye revealed that the maxillary and ethmoid sinuses were involved. A smear of purulent material from the left eye orbit revealed fungal elements, and cultures of the material grew a fungus. The isolate was identified as A. kalrae based on gross and microscopic morphologies, biochemical assays, and DNA sequence analysis. The patient received amphotericin B intravenously, itraconazole orally, and atomized allitridum by nebulizing allitridum therapy. The patient's wound healed following surgical intervention, but the patient lost the use of his left eye. This case should remind ophthalmologists and other clinicians to consider the possibility of infections being fungal when antibacterial agents have no effect and the patient's condition worsens.

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